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Surgery used to be considered a last-resort treatment option for people with Crohn’s disease — an indication that nothing else was working. “As a result, doctors who sent people with Crohn’s for surgery felt like they’d failed — but that’s no longer true,” says Raymond K. Cross, MD, professor of medicine and director of the inflammatory bowel disease (IBD) program at the University of Maryland School of Medicine in Baltimore. “Today, surgery is an option for Crohn’s that should be explored, particularly when complications are present. Any time I see a person with Crohn’s disease, I bring it up.”

Although newer medications have helped people control their disease (sometimes reducing the need for surgery altogether), surgical procedures are still very common, says Miguel Regueiro, MD, medical director of the University of Pittsburgh Medical Center's IBD Center in Pennsylvania. According to the Crohn’s & Colitis Foundation of America, up to 75 percent of all people with Crohn’s disease need surgery at some point as part of their treatment. Although surgery can’t cure Crohn’s, it can ease a person’s symptoms and provide long-term relief.

When Surgery for Crohn’s Is Recommended

Doctors are most likely to recommend surgery for Crohn’s if medications don’t work, stop working, or if you develop any of these complications:

A perforation or hole in your bowel

A blockage or a stricture (narrowing of the intestine)

A fistula (an abnormal passageway)

An abscess

Some of these complications may require emergency surgery. Surgery of the colon may also be recommended to reduce the risk for cancer, which is increased by the chronic inflammation caused by Crohn’s, Dr. Regueiro says.

Common Surgeries for Crohn’s

Crohn’s can affect any part of the gastrointestinal tract, although most typically the small intestine and colon are affected. Different types of surgical procedures for Crohn’s exist, depending on the complication you’re having, where it's located, and the severity of your disease.

Surgical options for Crohn’s include:

Strictureplasty: Over time, chronic inflammation from Crohn’s can scar your intestines, causing a stricture or a blockage. If the narrowing or blockage occurs in one of the lower sections of your small intestine (the jejunum or ileum), your doctor may recommend a strictureplasty, which is a surgery that involves cutting open the narrowed segment of bowel and stitching the tissue crosswise to widen it. None of the intestine is removed, which potentially lowers the risk for short bowel syndrome, Regueiro says.

Fistulotomy: Up to half of all adults with Crohn’s will develop a fistula, which occurs when an ulcer (or sore) caused by inflammation penetrates the wall of the gastrointestinal tract and forms a channel or loop in a nearby organ, such as the bladder, the skin, or, in women, the vagina. If antibiotics don’t resolve the problem, you may need this surgery to drain the infection and stop it from spreading.

Bowel resection: A bowel resection involves cutting out the section of bowel that’s diseased and reattaching the healthy ends. A bowel resection is used to treat strictures and bowel perforations, and is the most common surgery in Crohn’s disease, Regueiro says.

Colectomy and proctocolectomy: During a colectomy, the surgeon removes the entire colon. During a proctocolectomy, the surgeon removes the colon and rectum. A proctocolectomy requires an ileostomy, which creates an opening for stool to pass out of the body and requires that you wear an ostomy bag to collect it. Concern about having to live with an ostomy bag is normal, but after you adjust to it, you can resume your normal activities, and other people won’t know unless you choose to tell them. Your doctor may recommend a colectomy if your entire colon is affected by Crohn’s. You may need a proctocolectomy if your rectum is involved, but this is less common.

Minimally Invasive Surgery for Crohn’s

Today, surgeons often perform surgical procedures for Crohn’s using minimally invasive techniques, called laparoscopic surgery, which reduce post-operative pain and the risk for complications, including infection, and allow for a faster recovery. “In the old days, people who underwent surgery for Crohn’s had a scar from their sternum to their pelvis,” Dr. Cross says. With minimally invasive techniques, the incisions are much smaller and the cosmetic result is much better.

Laparoscopic procedures are best for people with Crohn’s who aren’t obese and who haven’t had previous abdominal surgeries. If your surgery is an emergency, your doctor may not be able to use minimally invasive techniques.

The Risks of Surgery for Crohn’s

Surgery for Crohn’s is generally safe and effective, and the results are usually good. It can dramatically reduce symptoms that may have been limiting your life. “Almost everyone gets better with surgery,” Cross says.

Still, every surgery has its risks, including those associated with anesthesia and possible bleeding and infection. A resection of more than half of the small intestine may lead to short bowel syndrome, which prevents the absorption of water, vitamins, and other nutrients from the food you eat, Regueiro says. This can cause you to become dangerously dehydrated and lose significant weight. Short bowel syndrome can be treated with nutritional support and medications, but it may require intravenous nutrition (TPN) or, in extreme cases, an intestinal transplant, Cross says.

People who undergo a bowel resection often need more surgeries down the road. “Within five years, 50 percent of people who undergo a bowel resection will come back because they’re having recurring symptoms,” Regueiro says. The inflammation they feel commonly reappears adjacent to where they had their surgery. “Why this happens is the mystery of why Crohn’s happens at all,” he notes. Some people may need two or more additional surgeries.

But this shouldn’t stop people with Crohn’s who need the surgery from having it, Regueiro says. If you have an advanced or deep-seated disease, he recommends seeing a surgeon about a bowel resection. Medications used for Crohn’s, particularly biologics, have been shown to slow the rate of symptom recurrence after surgery. Work with your doctor to develop a post-operative treatment plan. “The goal of surgery is to help keep you from getting sick again,” he says.

Is Surgery for Crohn’s Right for Me?

If surgery for Crohn’s has been recommended to you, ask your doctor to go over the risks and benefits in detail. If you decide to have surgery, do your best to care for yourself physically and mentally before your procedure, and build a support team that will help you prepare meals and manage other responsibilities while you’re recovering.

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